Closed band for percutaneous annuloplasty

Abstract

A method is provided, including, during a percutaneous transcatheter procedure, placing an annuloplasty device entirely around an annulus of a mitral valve of a subject in a closed loop. The annuloplasty device includes a flexible sleeve, which is fastened to the annulus by coupling a plurality of tissue anchors to a posterior portion of the annulus, without coupling any tissue anchors to any anterior portion of the annulus between left and right fibrous trigones of the annulus. After (a) placing the annuloplasty device entirely around the annulus in the closed loop and (b) fastening the flexible sleeve to the annulus, a longitudinal portion of the flexible sleeve is longitudinally contracted. Other embodiments are also described.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS[0001]The present application is a divisional of U.S. application Ser. No. 14 / 589,100, filed Jan. 5, 2015. The present application is also a continuation-in-part of U.S. application Ser. No. 15 / 474,543, filed Mar. 30, 2017, which is a continuation of U.S. application Ser. No. 14 / 128,756, filed Feb. 6, 2014, now U.S. Pat. No. 9,662,209, which is the U.S. national stage of International Application PCT / IL2012 / 000250, filed Jun. 21, 2012, which (a) is a continuation-in-part of U.S. application Ser. No. 13 / 167,444, filed Jun. 23, 2011, now U.S. Pat. No. 9,011,530, (b) is a continuation-in-part of U.S. application Ser. No. 13 / 167,476, filed Jun. 23, 2011, now U.S. Pat. No. 8,940,044, and (c) is a continuation-in-part of U.S. application Ser. No. 13 / 167,492, filed Jun. 23, 2011, now U.S. Pat. No. 8,926,697, which is assigned to the assignee of the present application and each of the foregoing applications is incorporated herein by reference.FIELD OF ...

AI Technical Summary

Benefits of technology

[0005]In some applications of the present invention, the contracting assembly includes one or more longitudinal contracting members coupled to the contracting mechanism. The implantable structure is placed completely around an annulus of an atrioventricular valve of a subject, such that none of the one or more longitudinal contracting members is positioned along an anterior portion of the annulus between fibrous trigones of the valve. The implantable structure is fastened to the annulus. The contracting assembly is then actuated to contract a longitudinal portion of the sleeve not positioned along the anterior portion of the annulus. Tightening of the implantable structure therefore tightens at least a portion of the posterior portion of the annulus, while preserving the length of the anterior portion of the annulus. (The anterior portion of the annulus should generally not be contracted because its tissue is part of the skeleton of the heart.) However, the portion of the sleeve deployed along the anterior portion of the annulus prevents dilation of the anterior annulus, because the sleeve is anchored at both ends of the anterior annulus, and the sleeve typically comprises a longitudinally non-extensible material. This deployment configuration may help prevent long-term resizing of annulus, especially the anterior annulus, which sometimes occurs after implantation of partial annuloplasty rings, such as C-bands.

[0043]The first distance equals at least twice the second distance, such as at least 2.5 times the second distance, e.g., at least 3 times the second distance. The first distance is measured between closest portions of the longitudinal-end tissue anchors of the first set, and the second distance is measured between closest portions of the longitudinal-end tissue anchors of the second set. The first and second sets do not share any common tissue anchors. After the tissue anchors are fastened to the annulus, a longitudinal portion of the sleeve is contracted. Providing the greater number of anchoring points with the second set better distributes forces among the anchors of this set.

Problems solved by technology

Mitral regurgitation of blood from the left ventricle into the left atrium results in increased total stroke volume and decreased cardiac output, and ultimate weakening of the left ventricle secondary to a volume overload and a pressure overload of the left atrium.

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